[10][11] In the metacognitive model,[2] symptoms are caused by a set of psychological processes called the cognitive attentional syndrome (CAS).
[12] Executive functions are also believed to play a part in how the person can focus and refocus on certain thoughts and mental modes.
[13][14][15][16] Clinical trials (including randomized controlled trials) have found MCT to produce large clinically significant improvements across a range of mental health disorders, although as of 2014 the total number of subjects studied is small and a meta-analysis concluded that further study is needed before strong conclusions can be drawn regarding effectiveness.
"[18] In 2020, a study showed superior effectiveness in MCT over cognitive behavioral therapy (CBT) in the treatment of depression.
"[19] In 2018–2020, a research topic in the journal Frontiers in Psychology highlighted the growing experimental, clinical, and neuropsychological evidence base for MCT.
[20] A recent network meta-analysis indicated that MCT (and cognitive processing therapy) might be superior to other psychological treatments for PTSD.
As such, there is a pressing need for larger, preferably pragmatic, well-conducted randomized controlled trials, conducted by independent trialists without potential conflict of interests before there is a large scale implementation of MCT in community mental health clinics.